Neuropsychological Instruction: A Process Related Approach in Early Reading Skill Development

Proficient and fluent reading ability for all Americans continues to be a highly prioritized, yet under achieved aspiration in current educational institutions. The acquisition of proficient reading fluency and comprehension are, undoubtedly, the most essential priorities in the academic development of school aged children, yet a discouraging number of students continue to struggle with the reading process throughout school aged years. Research has targeted key instructional areas that must be implemented in successful reading curriculum in the early childhood years. Namely, phonological awareness, phonics instruction, reading fluency, vocabulary development, and reading comprehension are core components that must be incorporated into literacy curricula and mastered by students as instruction is occurring in order to drive successful, long term reading outcomes. Advances in neurological research have added to current knowledge regarding how a child’s brain develops proficient reading ability. Neural networks are formed to create language systems, while brain plasticity in the first seven years of life allows for developmental manipulation. Despite these advances in knowledge and research, reading intervention continues to be reactive, and is usually applied after a student has fallen behind age expected benchmarks. There is a need for current research to demonstrate proactive methods to support successful literacy outcomes from the start of formal instruction, thereby thwarting the phenomenon of reading failure, and increasing reading proficiency for more students. Archival data were obtained from a program evaluation utilizing a pre/post test experimental design to measure reading gains for regular education Kindergarten students receiving balanced literacy instruction. The data were further examined to determine if students receiving balanced literacy instruction, in addition to the use of the PAL II Guides for Intervention as a proactive twelve week supplement to regular instruction, would realize greater gains in reading readiness than those students receiving balanced literacy instruction alone. All students (N = 31) who participated in the program evaluation were randomly assigned to one of two groups and received pre and post assessments in pre reading skill development. Findings indicate the use of a quality based, balanced literacy program does result in gains for writing legibility and speed; copying automaticity, legibility, and speed; receptive coding ability; auditory and verbal rhyming of words; phoneme segmentation and phoneme deletion; and syllable manipulation. Findings further indicate that the combined use of balanced literacy and the PAL II supplemental intervention yielded significant gains in writing automaticity, legibility and speed; copying automaticity, legibility, and speed; receptive coding; auditory and verbal rhyming of words; phoneme segmentation and phoneme deletion; syllabic manipulation; and verbal working memory. In an examination of the amount of measurable growth, those students receiving the PAL II supplement in addition to the balanced literacy program, made more statistically significant incremental gains than the group receiving balanced literacy alone in nine of the thirteen pre-reading skill variables. Medium effect sizes were noted for the balanced literacy plus intervention group over the balanced literacy group for writing automaticity, writing legibility, and copying automaticity. Large effect sizes were noted for the balanced literacy plus intervention group over the balanced literacy group for copying legibility, receptive coding, rhyming, syllables, phonemes, and verbal working memory. A small effect size was noted in writing speed but no effect size was noted for copying speed. These findings lend support to current research that emphasizes the importance of developing successful pre-reading skill acquisition in the early childhood years via the proactive use of quality instruction and supplemental intervention. Research further denotes the importance of early instruction while critical neural development is occurring in young learner’s language systems. Results from this study support this finding, and can be utilized as a proactive strategy to enhance learning for all students at the beginning of formal school instruction. By doing so, more young students are likely to develop improved mastery of the skills needed to become successful future readers, and fewer students will be left to struggle with reading skill development throughout school aged years

Complications Occurring Through 5 Years Following Primary Intraocular Lens Implantation for Pediatric Cataract

Importance Lensectomy with primary intraocular lens (IOL) implantation is often used in the management of nontraumatic pediatric cataract, but long-term data evaluating the association of age and IOL location with the incidence of complications are limited. Objective To describe the incidence of complications and additional eye surgeries through 5 years following pediatric lensectomy with primary IOL implantation and association with age at surgery and IOL location. Design, Setting, and Participants This prospective cohort study used Pediatric Eye Disease Investigator Group cataract registry data from 61 institution- and community-based practices over 3 years (June 2012 to July 2015). Participants were children younger than 13 years without baseline glaucoma who had primary IOL implantation (345 bilateral and 264 unilateral) for nontraumatic cataract. Data analysis was performed between September 2021 and January 2023. Exposures Lensectomy with primary IOL implantation. Main Outcome and Measures Five-year cumulative incidence of complications by age at surgery (<2 years, 2 to <4 years, 4 to <7 years, and 7 to <13 years) and by IOL location (sulcus vs capsular bag) were estimated using Cox proportional hazards models. Results The cohort included 609 eyes from 491 children (mean [SD] age, 5.6 [3.3] years; 261 [53%] male and 230 [47%] female). Following cataract extraction with primary IOL implantation, a frequent complication was surgery for visual axis opacification (VAO) (cumulative incidence, 32%; 95% CI, 27%-36%). Cumulative incidence was lower with anterior vitrectomy at the time of IOL placement (12%; 95% CI, 8%-16%) vs without (58%; 95% CI, 50%-65%), and the risk of undergoing surgery for VAO was associated with not performing anterior vitrectomy (hazard ratio [HR], 6.19; 95% CI, 3.70-10.34; P < .001). After adjusting for anterior vitrectomy at lens surgery, there were no differences in incidence of surgery for VAO by age at surgery (<2 years, HR, 1.35 [95% CI, 0.63-2.87], 2 to <4 years, HR, 0.86 [95% CI, 0.44-1.68], 4 to <7 years, HR, 1.06 [95% CI, 0.72-1.56]; P = .74) or by capsular bag vs sulcus IOL fixation (HR, 1.22; 95% CI, 0.36-4.17; P = .75). Cumulative incidence of glaucoma plus glaucoma suspect by 5 years was 7% (95% CI, 4%-9%), which did not differ by age after controlling for IOL location and laterality. Conclusions and Relevance In this cohort study, a frequent complication following pediatric lensectomy with primary IOL was surgery for VAO, which was associated with primary anterior vitrectomy not being performed but was not associated with age at surgery or IOL location. The risk of glaucoma development across all ages at surgery suggests a need for long-term monitoring